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| Public Act 097-0426 | ||||
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AN ACT concerning public aid.
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Be it enacted by the People of the State of Illinois,
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represented in the General Assembly:
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Section 5. The Illinois Public Aid Code is amended by | ||||
changing Section 5-5.12 as follows:
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(305 ILCS 5/5-5.12) (from Ch. 23, par. 5-5.12)
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Sec. 5-5.12. Pharmacy payments.
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(a) Every request submitted by a pharmacy for reimbursement | ||||
under this
Article for prescription drugs provided to a | ||||
recipient of aid under this
Article shall include the name of | ||||
the prescriber or an acceptable
identification number as | ||||
established by the Department.
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(b) Pharmacies providing prescription drugs under
this | ||||
Article shall be reimbursed at a rate which shall include
a | ||||
professional dispensing fee as determined by the Illinois
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Department, plus the current acquisition cost of the | ||||
prescription
drug dispensed. The Illinois Department shall | ||||
update its
information on the acquisition costs of all | ||||
prescription drugs
no less frequently than every 30 days. | ||||
However, the Illinois
Department may set the rate of | ||||
reimbursement for the acquisition
cost, by rule, at a | ||||
percentage of the current average wholesale
acquisition cost.
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(c) (Blank).
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(d) The Department shall not impose requirements for prior | ||
approval
based on a preferred drug list for anti-retroviral, | ||
anti-hemophilic factor
concentrates,
or
any atypical | ||
antipsychotics, conventional antipsychotics,
or | ||
anticonvulsants used for the treatment of serious mental
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illnesses
until 30 days after it has conducted a study of the | ||
impact of such
requirements on patient care and submitted a | ||
report to the Speaker of the
House of Representatives and the | ||
President of the Senate. The Department shall review | ||
utilization of narcotic medications in the medical assistance | ||
program and impose utilization controls that protect against | ||
abuse.
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(e) When making determinations as to which drugs shall be | ||
on a prior approval list, the Department shall include as part | ||
of the analysis for this determination, the degree to which a | ||
drug may affect individuals in different ways based on factors | ||
including the gender of the person taking the medication. | ||
(f) The Department shall cooperate with the Department of | ||
Public Health and the Department of Human Services Division of | ||
Mental Health in identifying psychotropic medications that, | ||
when given in a particular form, manner, duration, or frequency | ||
(including "as needed") in a dosage, or in conjunction with | ||
other psychotropic medications to a nursing home resident, may | ||
constitute a chemical restraint or an "unnecessary drug" as | ||
defined by the Nursing Home Care Act or Titles XVIII and XIX of | ||
the Social Security Act and the implementing rules and | ||
regulations. The Department shall require prior approval for | ||
any such medication prescribed for a nursing home resident that | ||
appears to be a chemical restraint or an unnecessary drug. The | ||
Department shall consult with the Department of Human Services | ||
Division of Mental Health in developing a protocol and criteria | ||
for deciding whether to grant such prior approval. | ||
(g) The Department may by rule provide for reimbursement of | ||
the dispensing of a 90-day supply of a generic or brand name, | ||
non-narcotic maintenance medication in circumstances where it | ||
is cost effective. | ||
(Source: P.A. 96-1269, eff. 7-26-10; 96-1372, eff. 7-29-10; | ||
96-1501, eff. 1-25-11.)
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